Sources: Research References/Bibliography
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Coverage of Drug-Induced Nutrient Depletion, Drug Brand Names, Contraindications, Warnings/Precautions, Adverse Reactions, Overdose/Toxicology, etc.
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Calcitonin-salmon
U.S. Brand Names: Calcimar®; Miacalcin®
Use: Used to preserve bone density in osteoporosis patients.
Pregnancy Risk Factor and Implications: C; only use this drug during pregnancy if the benefits of its use outweigh the risks. It is not know if this drug is excreted in human milk; recommended that don't nurse while on this drug.
Contraindications: Patients with an allergy to synthetic calcitonin-salmon should not use this drug.
Warnings/Precautions: Administration of calcitonin-salmon has been reported in a few cases to cause serious allergic-type reactions (e.g., bronchospasm, swelling of the tongue or throat, and anaphylactic shock), and in one case, death attributed to anaphylaxis (with injection, no serious allergic-type adverse reactions have been reported with the nasal spray). Also, the incidence of osteogenic sarcoma is known to be increased in Paget's disease. Use with caution since the administration of calcitonin possibly could lead to hypocalcemic tetany under special circumstances.
Adverse Reactions:
Injection: The injection form of calcitonin-salmon caused nausea with or without vomiting and local inflammatory reactions at the injection site in 10% of patients. Less than 5% reported flushing of face or hands, skin rashes, nocturia, pruritus of the ear lobes, feverish sensation, pain in the eyes, poor appetite, abdominal pain, edema of feet, and salty taste. In a few cases the injection caused serious allergic-type reactions such as bronchospasm, swelling of the tongue or throat, and anaphylactic shock, and in one case, death attributed to anaphylaxis.
Nasal Spray: The nasal spray form of calcitonin-salmon caused rhinitis, symptoms of the nose such as nasal crusts, dryness, redness or erythema, nasal sores, irritation, itching, thick feeling, pallor, infection, stenosis, runny/blocked, small wound, bleeding wound, tenderness, uncomfortable feeling, and a sore across the bridge of the nose in at least 10% of patients. Less than 5% reported back pain, epistaxis, and headache. Other side effects included the following:
- Body as a Whole: Influenza-like symptoms, fatigue, periorbital edema, fever
- Integumentary: Erythematous rash, skin ulceration, eczema, alopecia, pruritus, increased sweating
- Musculoskeletal/Collagen: Arthrosis, myalgia, arthritis, polymyalgia rheumatica, stiffness
- Respiratory/Special Senses: Sinusitis, upper respiratory tract infection, bronchospasm, pharyngitis, bronchitis, pneumonia, coughing, dyspnea, taste perversion, parosmia
- Cardiovascular: Hypertension, angina pectoris, tachycardia, palpitation, bundle branch block, myocardial infarction
- Gastrointestinal: Dyspepsia, constipation, abdominal pain, nausea, diarrhea, vomiting, flatulence, increased appetite, gastritis, dry mouth
- Liver/Metabolic: Cholelithiasis, hepatitis, thirst, weight increase
Endocrine: goiter, hyperthyroidism
- Urinary System: Cystitis, pyelonephritis, hematuria, renal calculus
- Central and Peripheral Nervous System: Dizziness, paresthesia, vertigo, migraine, neuraligia, agitation
- Hearing/Vestibular: Tinnitus, hearing loss, earache
- Vision: Abnormal lacrimation, conjunctivits, blurred vision, vitreous floater
- Vascular: flushing, cerebrovascular accident, thrombophlebitis
- Hematoloigy/Resistance Mechanisms: Lymphasdenopathy, infection, anemia
- Psychiatric: Depression, insomnia, anxiety, anorexia
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Raloxifene (Selective Estrogen Replacement Modulators/SERMS)
Nutrients Depleted: Magnesium, Vitamin B6, Zinc
U.S. Brand Names: Evista®
Use: Prevention of osteoporosis in women.
Pregnancy Risk Factor and Implications: X, do not take this drug if you are pregnant.
Contraindications: Pregnancy; prior hypersensitivity to raloxifene; active thromboembolic disorder.
Warnings/Precautions: History of venous thromboembolism/pulmonary embolism patients with cardiovascular disease; history of cervical/uterine carcinoma; renal/hepatic insufficiency (however, pharmacokinetic data are lacking); concurrent use of estrogens.
Adverse Reactions:
Greater than 2% experience:
- Cardiovascular: Chest Pain.
- Central nervous system: Migraine, depression, insomnia, fever.
- Dermatologic: Rash.
- Endocrine and metabolic: Hot flashes.
- Gastrointestinal: Nausea, dyspepsia, vomiting, flatulence, gastroenteritis, weight gain.
- Genitourinary: Vaginitis, urinary tract infection, cystitis, leukorrhea
- Neuromuscular and skeletal: Leg cramps, arthralgia, myalgia, arthritis
- Respiratory: Sinusitis, pharyngitis, cough, pneumonia, laryngitis
- Miscellaneous: Infection, flu syndrome, diaphoresis
Overdose/Toxicology: Incidence of overdose in humans has not been reported. In an 8-week study of post menopausal women, a dose of raloxifene 600 mg/day was safely tolerated. No mortality was seen after a single oral dose in rats or mice at 810 times the human dose for rats and 405 times the human dose for mice. There is no specific antidote for raloxifene.
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Alendronate
U.S. Brand Names: Fosamax®
Use: Used to reduce bone reabsorption in osteoporosis patients.
Pregnancy Risk Factor and Implications: C; use only if the benefit outweighs the risk. It is not known if this drug is excreted in human milk so nursing women should use caution.
Contraindications: Patients with abnormalities of the esophagus which delay emptying such as stricture or achalasia, the inability to stand or sit upright for at least 30 minutes, hypersensitivity to any component of this product, or hypocalcemia should not use this drug.
Warnings/Precautions: This drug may cause local irritation of the upper gastrointestinal mucosa. Esophageal adverse experiences, such as esophagitis, esophageal ulcers and esophageal erosions, occasionally with bleeding, have been reported in patients, in some cases these have been severe and required hospitalization. The risk of severe esophageal adverse experiences appears to be greater in patients who lie down after taking the drug and/or who fail to swallow it with a full glass of water, and/or continue to take the drug after developing symptoms. Use with caution in patients with active upper gastrointestinal problems, such as dysphagia, esophageal disease, gastritis, duodenitis, or ulcers. There have been rare reports of gastric and duodenal ulcers in patients, some severe and with complications. This drug is not recommended for patients with renal insufficiency. Hypocalcemia must be corrected before initiating therapy with this drug. Other deficiencies such as calcium and vitamin deficiencies should also be effectively treated before beginning treatment. Once treatment is begun it is important to monitor and maintain nutrient levels, especially calcium and vitamin D levels.
Adverse Reactions:
At least 1% experienced:
- Gastrointestinal: Abdominal pain, nausea, dyspepsia, constipation, diarrhea, flatulence, acid regurgitation, esophageal ulcer, vomiting, dysphagia, abdominal distention, gastritis, esophagitis, esophageal erosions, esophageal ulcers, and oropharyngeal ulceration, rarely gastric or duodenal ulcers, some severe and with complications
- Body as a Whole: Hypersensitivity reactions including urticaria and rarely angioedema
- Musculoskeletal: Musculoskeletal pain, muscle cramp
- Nervous system/Psychiatric: Headache, dizziness
- Special Senses: Taste perversion
Rarely, rash and erythema have occurred. A patient with a history of peptic ulcer disease and gastrectomy and who was taking concomitant aspirin developed as anastomotic ulcer with mild hemorrhage.
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Estrogen and Medroxyprogesterone
Nutrients Depleted: Magnesium, Vitamin B6, Zinc
U.S. Brand Names: Premphase™; Prempro™; Provera®
Use: Women with an intact uterus for the treatment of moderate to severe vasomotor symptoms associated with the menopause; treatment of atrophic vaginitis; primary ovarian failure; osteoporosis prophylactic.
Pregnancy Risk Factor and Implications: X, do not take this drug if you are pregnant. Excretion in breast milk is unknown/use caution.
Contraindications: Pregnancy, thrombophlebitis; hypersensitivity to estrogens or medroxyprogesterone or any component; cerebral apoplexy, undiagnosed vaginal bleeding; liver disease, carcinoma of the breast, estrogen dependent tumor.
Warnings/Precautions: Use with caution in patients with asthma, epilepsy, migraine, diabetes, cardiac or renal dysfunction; estrogens may cause premature closure of the epiphyses in young individuals; safety and efficacy in children have not been established; estrogens have been reported to increase the risk of endometrial carcinoma; pretreatment exams should include Pap smear, physical exam of breasts and pelvic areas. May increase serum cholesterol, LDL, decrease HDL and trigycerides; use of any progestin during the first 4 months of pregnancy if not recommended; monitor patients closely for loss of vision, sudden onset of proptosis, diplopia, migraine, and signs and symptoms of thromboembolic disorders.
Adverse Reactions:
Greater than 10% experience:
- Cardiovascular: Edema, peripheral edema
- Endocrine and metabolic: Breakthrough bleeding, spotting, changes in menstrual flow, amenorrhea, enlargement of breasts, breast tenderness
- Gastrointestinal: Anorexia, nausea, bloating
- Local: Pain at sight of injection
- Neuromuscular and skeletal: Weakness
1% to 10% experience:
- Cardiovascular: Edema, central thrombosis
- Central Nervous System: Mental depression, fever, insomnia, headache
- Dermatologic: Melasma, cholasma, allergic rash with or without pruritus
- Endocrine and Metabolic: Increased breast tenderness, increased libido
- Gastrointestinal: Weight gain or loss, vomiting, diarrhea
- Genitourinary: Changes in cervical erosion and secretions
- Hepatic: Cholestatic jaundice
- Local: Thrombophlebitis
- Respiratory: Embolism
Less than 1% experience:
- Cardiovascular: Hypertension, thromboembolism,myocardial infarction
- Central Nervous System: Stroke, depression, dizziness, anxiety
- Endocrine and metabolic: Alterations in frequency and flow of menses, decreased glucose tolerance, increased triglycerides and LDL
- Gastrointestinal: Gastrointestinal distress
- Ocular: Intolerance to contact lenses
- Miscellaneous: Increased susceptibility to Candida infection breast tumors
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Nutrients Depleted: Magnesium, Vitamin B6, Zinc
U.S. Brand Names: Premarin®
Use: Atrophic vaginitis; hypogonadism; primary ovarian failure; vasomotor symptoms of menopause; prostatic carcinoma; osteoporosis prophylactic
Pregnancy Risk Factor and Implications: X, do not take this drug if you are pregnant. Enters breast milk/use caution.
Contraindications: Undiagnosed vaginal bleeding; hypersensitivity to estrogens or any component; thrombophlebitis, liver disease, known or suspected pregnancy, carcinoma of the breast, estrogen dependent tumor.
Warnings/Precautions: Use with caution in patients with asthma, epilepsy, migraine, diabetes, cardiac or renal dysfunction; estrogens may cause premature closure of the epiphyses in young individuals; safety and efficacy in children have not been established; estrogens have been reported to increase the risk of endometrial carcinoma; do not use estrogens during pregnancy.
Adverse Reactions:
At least 10% experience:
- Cardiovascular: Peripheral edema.
- Endocrine and metabolic: Breast tenderness, hypercalcemia, enlargement of breasts.
- Gastrointestinal: Nausea, anorexia, bloating.
1% to 10% experience:
- Central nervous system: Headache
- Endocrine and metabolic: Increased libido
- Gastrointestinal: Vomiting, diarrhea
- Local: Pain at injection site
Less than 1% experience: Increase in blood pressure, edema, thromboembolic disorder, myocardial infarction, hypertension, depression, dizziness, anxiety, stroke, cholasma, melasma, rash, breast tumors, amenorrhea, alterations in frequency and flow of menses, decreased glucose tolerance, increased triglycerides and LDL, GI distress, cholestatic jaundice, intolerance to contact lenses, increased susceptibility to Candida infection.
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Esterified Estrogens
Nutrients Depleted: Magnesium, Vitamin B6, Zinc
U.S. Brand Names: Estratab®; Menest®
Use: Atropic vaginitis; hypogonadism; primary ovarian failure; vasomotor symptoms of menopause; prostatic carcinoma; osteoporosis prophylactic
Pregnancy Risk Factor and Implications: X, do not take this drug if you are pregnant. Use caution when nursing.
Contraindications: Known or suspected cancer of the breast, except in appropriately selected patients being treated for metastic disease; known or suspected estrogen-dependent neoplasia; known or suspected pregnancy; undiagnosed abnormal genital bleeding; active thrombophlebitis or thromboembolic disorders; past history of thrombophlebititis. thrombosis, or thromboembolic disorders; past history of thrombosis, thromboembolic disorders associated with previous estrogen use except when used in the treatment of breast or prostatic malignancy.
Warnings/Precautions: Use with caution in patients with asthma, epilepsy, migraine, diabetes, cardiac or renal dysfunction; estrogens may cause premature closure of the epipyses in young individuals; safety and efficacy in children have not been established; estrogens have been reported to increase the risk of endometrial carcinoma, do not use estrogens during pregnancy.
Adverse Reactions:
At least 10% experience:
- Cardiovascular: Peripheral edema
- Endocrine and metabolic: Enlargement of breasts, breast tenderness
- Gastrointestinal: Nausea, anorexia, vomiting
1% to 10% experience:
- Central Nervous System: Headache
- Endocrine and metabolic: Increased libido
- Gastrointestinal: Vomiting, diarrhea
Less than 1% experience: Hypertension, thromboembolism, myocardial infarction, edema, stroke, depression, dizziness, anxiety, cholasma, melasma, rash, amenorrhea, alterations in frequency and flow of menses, decreased glucose tolerance, increased triglycerides and LDL, GI distress, cholestatic jaundice, intolerance to contact lenses, increased susceptibility to Candida infection, breast tumors.
Overdose/Toxicology: Symptoms of overdose include fluid retention, jaundice, and thrombophlebitis. Toxicity is unlikely following single exposure of excessive doses. Treatment should be supportive and symptomatic.
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